Is Estrogen a Therapeutic Target for Glaucoma?
Is Estrogen a Therapeutic Target for Glaucoma?
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DOI：
10.3109/08820538.2015.1114845
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发表时间：
2016
影响因子：
1.7
通讯作者：
Pasquale LR
中科院分区：
文献类型：
--
作者：
Dewundara SS;Wiggs JL;Sullivan DA;Pasquale LR
概述雌激素与青光眼之间的关系。使用PubMed数据库对截至2015年5月5日在同行评审期刊上发表的文章进行文献综述。使用的关键词是“雌激素和青光眼”，“生殖因素和青光眼”，“雌激素，一氧化氮和眼睛”。共纳入43篇期刊文章。几项研究已经测量了终生雌激素暴露的标志物，并显示初潮开始的年龄、口服避孕药（OC）的使用、双侧卵巢切除术、绝经开始的年龄和初潮至绝经的持续时间与原发性开角型青光眼（POAG）风险相关。蓝山眼科研究发现，与初潮年龄早（≤12岁）相比，初潮年龄晚（>13岁）的POAG风险显著增加。护士健康研究（NHS）的研究人员发现，使用OC超过5年与POAG风险增加25%相关。马约诊所卵巢切除术与衰老的队列研究发现，43岁之前接受双侧卵巢切除术的女性患青光眼的风险增加。鹿特丹研究发现，在45岁之前经历更年期的女性患开角型青光眼的风险更高（风险增加2.6倍），而NHS显示，65岁以上进入绝经期的女性患开角型青光眼的风险降低年龄≥ 54岁。增加的雌激素状态可以降低青光眼或青光眼相关特征的风险，例如降低的眼内压（IOP）。妊娠是一种高雌激素血症状态，与妊娠晚期IOP降低相关。虽然绝经后激素（PMH）在降低IOP中的作用还没有完全确定，但PMH的使用可能会降低POAG的风险。从遗传流行病学的角度来看，雌激素代谢途径单核苷酸多态性（SNP）与女性POAG相关，内皮型一氧化氮合酶（一种接受雌激素调节的基因）多态性与青光眼相关。越来越多的证据表明，终生暴露于雌激素可能会改变青光眼的发病机制。雌激素暴露可能对POAG的进展具有神经保护作用，但需要进一步的研究来证实这一发现。针对性别的预防和治疗可能即将发挥作用。
To provide an overview of the association between estrogen and glaucoma. A literature synthesis of articles published in peer review journals screened through May 05, 2015 using the PubMed database. Key words used were “estrogen and glaucoma,” “reproductive factors and glaucoma,” “estrogen, nitric oxide and eye.” Forty three journal articles were included. Markers for lifetime estrogen exposure have been measured by several studies and show that the age of menarche onset, oral contraceptive (OC) use, bilateral oophorectomy, age of menopause onset and duration between menarche to menopause are associated with primary open angle (POAG) risk. The Blue Mountain Eye Study found a significantly increased POAG risk with later (>13 years) compared with earlier (≤12 years) age of menarche. Nurses’ Health Study (NHS) investigators found that OC use of greater than 5 years was associated with a 25% increased risk of POAG. The Mayo Clinic Cohort Study of Oophorectomy and Aging found that women who underwent bilateral oophorectomy before age 43 had an increased risk of glaucoma. The Rotterdam Study found that women who went through menopause before reaching the age of 45 years had a higher risk of open-angle glaucoma (2.6-fold increased risk) while the NHS showed a reduced risk of POAG among women older than 65 who entered menopause after age ≥ 54 years. Increased estrogen states may confer a reduced risk of glaucoma or glaucoma related traits such as reduced intraocular pressure (IOP). Pregnancy, a hyperestrogenemic state, is associated with decreased IOP during the third trimester. Though the role of post-menopausal hormone (PMH) use in the reduction of IOP is not fully conclusive, PMH use may reduce the risk of POAG. From a genetic epidemiologic perspective, estrogen metabolic pathway single nucleotide polymorphisms (SNPs) were associated with POAG in women and polymorphisms in endothelial nitric oxide synthase, a gene receptive to estrogen regulation, are associated with glaucoma. Increasing evidence suggests that lifetime exposure to estrogen may alter the pathogenesis of glaucoma. Estrogen exposure may have a neuroprotective effect on the progression of POAG but further studies need to confirm this finding. The role of sex-specific preventive and therapeutic treatment may be on the horizon.